Fall Prevention

Causes and Risk Factors for Falls

Written by Clinical Rehab Services

Myth

• People fall because they get older.

This is false. Often, more than one underlying cause or risk factor is involved in a fall. A risk factor is something that increases a person's risk or likelihood to develop a medical issue or health decline.

Reality

As the number of risk factors rises, so does the risk of falling. Many falls are linked to a person's physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person's home or community environment.

Falls are the main cause for injuries in people 65 years of age and older and can happen at any age, anytime and anywhere. Most falls happen in homes during common activities. Serious injuries can happen such as hip, spine or wrist fractures and head injuries.

Risk Factors

Research indicates there are many possible risks that increase the chance of falling. Some of these include:

1. Muscle weakness, especially in the legs, is one of the most important risk factors. Older people with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance.
2. Balance and gait are other key factors. Older adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or other medical conditions and their treatments.
3. Blood pressure that drops too much when getting up from lying down or sitting can increase chances of falling. This condition -- called postural hypotension -- might result from dehydration, or certain medications. It might also be linked to diabetes, neurological conditions such as Parkinson's disease, or an infection.
4. Some people with postural hypotension feel dizzy when their blood pressure drops. Other people don't feel dizzy, even if their blood pressure drops a lot when they get up.
5. Reflexes may also be slower with increased age. The increased amount of time it takes you to react may make it harder to catch your balance if you start to fall.
6. Foot problems that cause painful feet, and wearing unsafe footwear can increase chances of falling. Backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles are examples of unsafe footwear that could cause a fall.
7. Sensory problems can cause falls, too. If the senses don't work well, one might be less aware of their environment. For instance, numbness in the feet may cause inability to feel a change in the flooring or to feel a threshold that could cause a trip.
8. Vision problems contributing to falls include poor depth perception, cataracts, and glaucoma.Wearing multi-focal glasses while walking or having poor lighting around the home can also lead to falls.
9. Some medications can increase a person's risk of falling because they cause side effects like dizziness or confusion. The health problems for which the person takes the medications may also contribute to the risk of falls. People who take four or more prescription drugs have a greater risk of falling than do people who take fewer medications.

Most Falls Happen at Home

Although falls can happen anywhere, well over half of all falls happen at home. Falls at home often happen while a person is doing normal daily activities. Some of these falls are caused by factors in the person's living environment. For instance, a slick floor or a poorly lit stairway may lead to a fall.

Other factors that can lead to falls at home include

• loose rugs
• clutter on the floor or stairs
• carrying heavy or bulky things up or down stairs
• not having stair railings
• not having grab bars in the bathroom

Simple Changes for Home Safety

Six out of every 10 falls happen at home, where we spend much of our time and tend to move around without thinking about our safety. Many falls could be prevented by making simple changes in your living areas, as well as personal and lifestyle changes.

Take steps to "fall proof" your home, both inside and outdoors. To make your home safer, you can

• remove or avoid safety hazards
• improve lighting
• install handrails and grab bars
• move items to make them easier to reach.

Tips to "Fall Proof" Your Home

1. An important step toward preventing falls at home is to remove anything that could cause you to trip or slip while walking. Tripping on clutter, small furniture, pet bowls, electrical or phone cords, or other things can cause you to fall. Slipping on rugs or slick floors can also cause falls.
2. Arrange furniture to give you plenty of room to walk freely. Also remove items from stairs, hallways, and pathways.
3. Be sure that carpets are secured to the floor and stairs. Remove throw rugs, use non-slip rugs, or attach rugs to the floor with double-sided tape.
4. Put non-slip strips on floors and steps. Put non-slip strips or a rubber mat on the floor of your bathtub or shower, as well. You can buy these items at a home center or hardware store.
5. At home and elsewhere, try to avoid wet floors and clean up spills right away. Use only non-skid wax on waxed floors at home.
6. Be careful when walking outdoors, and avoid going out alone on ice or snow. A simple slip on a slick sidewalk, a curb, or icy stairs could result in a serious injury.
7. During the winter, ask someone to spread sand or salt on icy surfaces. Be sure to wear boots with good traction if you must go out when it snows. Better yet, don't take chances walking on icy or slippery surfaces.
8. Poor lighting -- inside and outdoors -- can increase your risk of falls. Make sure you have enough lighting in each room, at entrances, and on outdoor walkways. Use light bulbs that have the highest wattage recommended for the fixture.
9. Good lighting on stairways is especially important. Light switches at both the top and bottom of stairs can help.
10. Place a lamp within easy reach of your bed. Put night lights in the bathroom, hallways, bedroom, and kitchen. Also keep a flashlight by your bed in case the power is out and you need to get up.
11. Have handrails installed on both sides of stairs and walkways. If you must carry something while walking up or down stairs, hold the item in one hand and use the handrail with the other. When you're carrying something, be sure you can see where your feet are stepping.
12. Properly placed grab bars in your tub and shower, and next to the toilet, can help you avoid falls, too. Have grab bars installed, and use them every time you get in and out of the tub or shower. Be sure the grab bars are securely attached to the wall.
13. You might find it helpful to rearrange often-used items in your home to make them more accessible. Store food boxes, cans, dishes, clothing, and other everyday items within easy reach. This simple change could prevent a fall that might come from standing on a stool to get to an item.

If you have fallen, your doctor might suggest that an occupational therapist, physical therapist, or nurse visit your home. These health care providers can assess your home's safety and advise you about making changes to prevent falls.